Homelessness Response: A Framework for Action by Hospitals and Healthcare Systems

Joy C Liu^1*Cate J Ryan²Jeff Olivet²Emily Lazowy²Howard Koh²

• ¹Alameda Health System, Oakland, United States
• ²Harvard T H Chan School of Public Health, Boston, United States

While healthcare systems have long attempted various strategies to care for unhoused patients, the rising complexity and severity of the homelessness crisis have underscored the urgent need for systemic approaches. Such efforts are critical as current federal policies push more responsibility for homelessness prevention and response to states and localities. Few studies have identified frameworks that healthcare systems can use to guide unified responses to the homelessness. In particular, support is needed to address how healthcare systems can operate across levels beyond individual care to improve patient health. To assess current and potential best practices, we conducted a literature search on healthcare system involvement in homelessness and conducted key informant interviews with experts from healthcare systems and national and local homelessness organizations. We grouped a wide spectrum of health-system responses into ten categories: screening, Health Care for the Homeless programs, medical respite, wraparound services, medical-legal partnerships, investment in affordable housing, healthcare and housing partnerships, data sharing, anchor institutions, and implementation of federal programs. Drawing on the socioecological model, this typology provides a framework that presents the ten categories for homelessness interventions on three interconnected levels— institution-based practices, community partnerships, and public policy. It also provides a foundation for further research, financial impact analysis, and program evaluation.